The future of academic neurology: a Colorado perspective

Training clinical researchers in neurology: we must do better

The pace of scientific discoveries, the increasing complexity of managing patients, and the runaway cost of neurological services have created an urgent need for a wide range of clinical research in neurology. Despite increasing recognition of this need and recent increases in funding for training clinical investigators, neurologists conducting cellular and molecular investigations are more likely to join faculties, maintain research careers, and attain academic advancement. Because academic departments of neurology are successful in producing and nurturing basic science researchers, why aren't they just as triumphant in spawning clinical investigators? This crisis in the preparation of clinical investigators has been brought about by many factors: competing time demands for clinical service, lack of methodologically rigorous training in the disciplines necessary to conduct clinical research, and lack of mentorship. Neurology residents contemplating a clinical research career may observe junior faculty who lack career guidance, are ill-prepared as independent investigators, and must juggle patient demands while trying to write a research grant or conduct a study. Already burdened by medical school debts, is it any wonder that our neurology graduates don't leap to a career with a future that seems so insecure? Academic departments of neurology must develop full-scale clinical research training programs if they are to meet the pressing need for clinical research. As a starting point, they must free themselves from their dependence on providing clinical services to generate income. Following the model which has produced successful basic researchers, much greater effort must be given to establishing rigorous methodological training in collaboration with other departments, creating senior role models, and protecting time for clinical investigators to conduct research. Unless we create incentives to careers in clinical research, we will never answer the growing number of clinical research questions we face today.

Can neurologists survive or thrive with health care reform?

The economics of present-day health care and the politics of recent elections will forever change the practice of neurology. Managed care, outcomes research, limits on price and volume of services, diagnostic and treatment restraint, divestiture of ownership in health facilities, malpractice reform, increased use of preventive services, and administrative simplifications will all be part of the new practice of medicine, and hence neurology. The challenge for neurologists will be to define cost-effective neurological services, put greater emphasis on the most prevalent and costly diseases of the nervous system, and convince primary care providers and patients of their value. Health care reform is an opportunity and challenge for neurologists to improve patient access while achieving acceptable financing mechanisms.

A private practice model for teaching and research activities

The majority of neurologists in the United States are in fee for service patient management, dividing their time between hospital and office based practice. Many have had subspecialty training or have had research experience. It is our belief that research should be a component of a neurologist's practice. This is particularly true for an assessment of outcome. In order to accomplish this, we have developed a system which includes patient management, teaching, and clinical research, within our fee for service model.